Predictors of Serious Opioid-Related Adverse Drug Events in Hospitalized Patients.


Journal

Journal of patient safety
ISSN: 1549-8425
Titre abrégé: J Patient Saf
Pays: United States
ID NLM: 101233393

Informations de publication

Date de publication:
01 Dec 2021
Historique:
pubmed: 6 6 2020
medline: 24 2 2022
entrez: 6 6 2020
Statut: ppublish

Résumé

Opioids are high-risk medications in the inpatient setting because of their potential for significant patient harm. The primary objective was to identify risk factors that predispose inpatients to develop opioid-related adverse drug events (ORADE) requiring the use of naloxone. In a retrospective case-control study, patients were included according to the following criteria: 18 years or older, 1 administered opioid doses or more, and admitted for 24 hours or more. Patients were excluded if they had a prehospital drug overdose, other indications for naloxone use, or were admitted to an intensive care unit, psychiatric medical unit, or in the emergency department. Patients were classified as cases if naloxone was administered and a selection of controls were frequency matched 2:1 based on medical or surgical status. A logistic regression model was used to evaluate for risk factors for ORADE. A total of 275 cases and 592 control patients were included into the final analysis. Variables that were associated with greater odds of naloxone administration included age of 65 years or older, female, length of stay, pulmonary diagnoses, use of gabapentinoids, and patient-controlled analgesia use. Antihistamines, continuous infusion, and intermittent nurse administered intravenous bolus routes had a negative association with naloxone use. Several risk factors were found to be associated with ORADE supporting many of the previously described risk factors, and the discovery of potential new ones, such as gabapentinoid use. Health care providers should consider the risk factors for hospitalized patients receiving opioids who may warrant lower doses, additional monitoring, or alternative agents.

Identifiants

pubmed: 32502115
pii: 01209203-202112000-00124
doi: 10.1097/PTS.0000000000000735
doi:

Substances chimiques

Analgesics, Opioid 0
Narcotic Antagonists 0
Naloxone 36B82AMQ7N

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e1585-e1588

Informations de copyright

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Déclaration de conflit d'intérêts

The authors disclose no conflict of interest.

Références

Joint Commission. Sentinel event alert: safe use of opioids in hospitals, issue 49, August 2012. Available at: http://www.jointcommission.org/ . Accessed September 4, 2019.
Institute for Safe Medication Practices. High-alert medications in acute care settings. Available at: https://www.ismp.org/recommendations/high-alert-medications-acute-list Accessed September 4, 2019.
Pawasauskas J, Stevens B, Youssef R, et al. Predictors of naloxone use for respiratory depression and oversedation in hospitalized adults. Am J Health Syst Pharm . 2014;71:746–750.
Chidambaran V, Olbrecht V, Hossain M, et al. Risk predictors of opioid-induced critical respiratory events in children: naloxone use as a quality measure of opioid safety. Pain Med . 2014;15:2139–2149.
Weingarten TN, Herasevich V, McGlinch MC, et al. Predictors of delayed postoperative respiratory depression assessed from naloxone administration. Anesth Analg . 2015;121:422–429.
Brant JM, Stringer L, Jurkovich LR, et al. Predictors of oversedation in hospitalized patients. Am J Health Syst Pharm . 2018;75:1378–1385.
Shafi S, Collinsworth AW, Copeland LA, et al. Association of opioid-related adverse drug events with clinical and cost outcomes among surgical patients in a large integrated health care delivery system. JAMA Surg . 2018;153:757–763.
Frasco PE, Sprung J, Trentman TL. The impact of the joint commission for accreditation of healthcare organizations pain initiative on perioperative opiate consumption and recovery room length of stay. Anesth Analg . 2005;100:162–168.
Muething S, Conway P, Kloppenborg E, et al. Identifying causes of adverse events detected by an automated trigger tool through in-depth analysis. Qual Saf Health Care . 2010;19:435–439.
Rozich JD, Haraden CR, Resar RK. Adverse drug event trigger tool: a practical methodology for measuring medication related harm. Qual Saf Health Care . 2003;12:194–200.
Miller R. Analgesics. In: Drug Effects in Hospitalized Patients . New York: John Wiley; 1976:133–164.
Etches RC. Respiratory depression associated with patient-controlled analgesia: a review of eight cases. Can J Anaesth . 1994;41:125–132.
Oderda GM, Said Q, Evans RS, et al. Opioid-related adverse drug events in surgical hospitalizations: impact on costs and length of stay. Ann Pharmacother . 2007;41:400–407.
R3 Report Issue 11: Pain Assessment and Management Standards for Hospitals. [report]. Joint Commission. August 29, 2017.
Jensen MD, Ryan DH, Apovian CM, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society. J Am Coll Cardiol . 2014;63(25 Pt B):2985–3023.
Swarm RA, Paice JA, Anghelescu DL, et al. Adult cancer pain, version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw . 2019;17:977–1007.
Ho KY, Gan TJ, Habib AS. Gabapentin and postoperative pain—a systematic review of randomized controlled trials. Pain . 2006;126:91–101.
Matthews EA, Dickenson AH. A combination of gabapentin and morphine mediates enhanced inhibitory effects on dorsal horn neuronal responses in a rat model of neuropathy. Anesthesiology . 2002;96:633–640.
Gilron I, Biederman J, Jhamandas K, et al. Gabapentin blocks and reverses antinociceptive morphine tolerance in the rat paw-pressure and tail-flick tests. Anesthesiology . 2003;98:1288–1292.
Craft J. Patient-controlled analgesia: is it worth the painful prescribing process? Proc (Bayl Univ Med Cent) . 2010;23:434–438.
Kapur V, Strohl KP, Redline S, et al. Underdiagnosis of sleep apnea syndrome in U.S. communities. Sleep Breath . 2002;6:49–54.

Auteurs

Faisal Syed Minhaj (FS)

From the Department of Pharmacy Services, University of Rochester Medical Center, Rochester, NY.

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